May 9th, 2008 by Dr. Val Jones in Celebrity Interviews, Health Policy
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This is a continuation of my interview with Mike Huckabee at the National Changing Diabetes Program conference in Washington, DC. In my previous post I asked Mike about his weight loss journey, and in this post I asked him some global questions about healthcare. My regular readers will appreciate that my digital voice recorder did not malfunction during this interview, though I did drop my Blackberry at one point out of sheer enthusiasm. Gov. Huckabee was the first to reach down and help me get it. What a gentleman!
Dr. Val: Your friend, Dr. Fay Boozman, said “We need to stop treating snake bites and start killing snakes.” Tell me what that means in practical terms.
Huckabee: Healthcare in America is reactive and is geared towards intervening in catastrophic situations, when what we should be doing is focusing on preventing them. The whole system is upside down. It’s like we’re focused on putting Humpty Dumpty back together again instead of keeping him from falling off the wall. Our healthcare system is based on a broken egg concept.
So the key thing that we have to change in healthcare is to focus our resources on prevention and a healthy lifestyle.
Dr. Val: You said that your hope was that “‘Healthy Arkansas’ will spread like a highly contagious but benevolent virus that could become the genesis of ‘Healthy America.'” Can you give me a virus update?
Huckabee: We did in fact launch “Healthy America” and it was the most successful Governors’ initiative in that we had more states participate in this than any other NGA (National Governors’ Association) initiative. Forty-three states launched state-based health initiatives for preventive health. Some were more aggressive than others.
We began the initiative because there was a new awareness of the need to change the healthcare model from intervention to prevention. The concept of Healthy America was to influence behaviors at work, at play, at home, and at school. These programs have been remarkably successful. For example, in the first year, the average productivity of state employees increased by $3400/year. And that’s not to mention the savings in healthcare costs. The average diabetic spends 8.3 days/year in the hospital. The cost of those days could pay for 7 years of diabetes counseling and medication. It’s as if the choice is between a new oil filter or a new engine – which do you think is going to be less expensive?
Dr. Val: Revolution Health is attempting to encourage behavior modification through social networking and online, physician-led programs. What do you think are the strengths and limitations of this approach?
Huckabee: First of all the strengths are more dramatic than you may realize. When we used the online approach in Arkansas, we did health risk assessments followed by online coaching for everything from smoking cessation to weight control. Online programs can be very successful because they’re instant and accessible 24 hours/day. The socialization becomes very important because peer pressure can be harnessed to challenge people to walk more steps or lose more pounds than the others in their group.
Online approaches aside, the key to improving health in America is to create an atmosphere of healthy behavior. This cultural change may take a generation to achieve, which is why most politicians don’t touch it. Politicians like to deal with issues that can be dealt with in an election cycle, not a generation.
However, America’s approach to littering, seatbelt laws, smoking, and drunk driving are four examples of real changes we’ve made in this country over time. The changes took place in three stages: attitude change, atmosphere change, then an action is changed.
Attitude change involves giving people information that changes the way they think about an issue. Atmosphere change means making unhealthy behaviors difficult to participate in (like taking away ash trays and putting up a no-smoking sign), and finally the government codifies into law the new behavioral norm.
The government is usually the last player, not the first, because people have to create the behavioral norm before the government can enact laws. If the government tries to mandate a personal habit, then the debate will not be over the merits of the approach, but over the personal liberties of people to do what they want to do. And in America, the government always loses that argument. So what you have to do is get enough Americans believing that taking care of themselves is the right thing to do, and then there will be the demand for government to put that into law.
We don’t have a healthcare crisis in America, we have a health crisis. And if we dealt with the health crisis we would resolve the healthcare crisis. The real reason we’re in trouble is because 80% of the money we spend on healthcare is a result of chronic disease. And that chronic disease is primarily the result of over-eating, under-exercising and smoking. It’s our lifestyle that’s killing us.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 28th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.
Dr. Val: What is the most important message that Americans need to hear about chronic disease?
Dr. Carmona: The public needs to realize that we are spending more than 16% of our gross national product on healthcare, which amounts to over 2 trillion dollars per year. If you follow the curves out, and don’t do anything to change them, within the next decade we’ll be spending 20% of our GNP, or 4.1 trillion dollars per year. So the legacy we will leave our children in both disease burden and economic burden is unsustainable.
On top of that, 75 cents of every dollar we spend on healthcare is on chronic disease, most of which can at least be mitigated if not prevented. The Partnership to Fight Chronic Disease recognizes this and has put together a coalition of academic and business organizations and advocacy groups to get the word out to the American public that fighting chronic disease is one of the best ways to begin to transform from a “sick-care system” to a “healthcare system.” The PFCD now has 110 partners and growing, because so many people recognize what we recognize – prevention of chronic disease is cost-effective and saves lives.
We need to do everything we can to prevent these chronic diseases, and we hope that more communities, employers, and patient groups will join us. We’re a non-partisan, non-profit organization, and all of us are trying to make the health of the nation better through the most cost-effective preventive strategies. Eliminating chronic disease is one of those main goals.
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The Surgeon General series: see what else Dr. Carmona has to say about…
Cost Savings Associated with Preventive Health
Obesity is America’s #1 Health Concern
Consumer Directed Healthcare and Health Literacy
Complementary and Alternative MedicineThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 24th, 2008 by Dr. Val Jones in Expert Interviews
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Here it is… the long anticipated interview about chronic disease with Dr. Richard Carmona, 17th Surgeon General of the United States. I asked him 5 key questions and will split the Q&A into 5 posts. Enjoy!
Dr. Val: What do you say to those who argue that disease prevention is critical for quality of life, but does not ultimately reduce costs?
Dr. Carmona: The real value of prevention is best captured by some of the simpler interventions that have little or no cost to implement, such as smoking cessation. The returns on these prevention strategies are huge, and the only “cost” is in educating people to change their behaviors. Another great example is childhood vaccination – it costs pennies per child but protects them from polio and other deadly diseases.
In the recent past there have been a number of editorials where learned individuals have cited examples such as the cost of treating hyperlipidemia in the population at large. For every heart attack that lipid-lowering drugs prevent, it costs hundreds of thousands of dollars to provide the drugs to the population with high cholesterol. I guess if you’re the one with the heart attack it is worth it. But not withstanding that issue, I think the argument is a misapplication of the concept of prevention.
If you look at prevention in the appropriate light, you can make the business case for it. Health itself and quality of life are priceless things. We need to provide the right drug for the right person at the right time. But better yet, lifestyle interventions like physical activity and healthy eating behaviors can eliminate the need for many medications.
The real issue here is how to attain optimal health and wellness through appropriately vetted prevention strategies that will reduce the cost of care while improving the quality and quantity of life. That is the challenge we have before us and I’m working to answer as chairperson of the Partnership to Fight Chronic Disease.
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The Surgeon General series: see what else Dr. Carmona has to say about…
Obesity is America’s #1 Health Concern
Consumer Directed Healthcare and Health Literacy
Complementary and Alternative Medicine
Preventing Chronic DiseaseThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 23rd, 2008 by Dr. Val Jones in Medblogger Shout Outs
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My radiologist friend in India pointed out an interesting blog post of his (via Twitter*) today. See if you can pick your jaw up off the floor on this one:
A basic MDCT scanner (6 or 8 detector rows) costs about 2 to 2.5 crore rupees here in India (INR 20 to 25 million = US $ 500,000 to 630,000). I learnt from a source in the industry that the cost of the scanner is about 40% subsidized for the Indian market (compared to its cost in the North American & European markets). So the same basic multislice CT scanner would cost about $ 900,000 in the US.
We have a basic four-slice MDCT scanner in our hospital. A patient would be charged Rs. 3500 ($ 90, yes ninety dollars) for a plain CT scan or Rs. 4500 ($ 115) for a contrast CT scan of the whole abdomen. Ours is a small city. The charges are likely to be as high as Rs. 8000 or Rs. 9000 ($ 200 to 230) in the bigger metros like Chennai, Mumbai or Delhi.
Compare that price to a patient in the US who was charged $6,500 for an abdominal CT scan.
(Usual cost is ~$2000, but still!)
*If you’d like to follow me on twitter.com, my user name is drval. Check it out for quick updates and daily eyebrow raises.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 3rd, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Well, I know that blog post title probably got your attention. I’m referring, of course, to the unusual career path of Paul Levy, CEO of Harvard’s Beth Israel Deaconess Medical Center in Boston. Paul has done wonderful things over the past several years as CEO, including using his blog to promote outcomes transparency (by making his hospital’s infection rates public) and being accessible to all his staff via Facebook.
I had the chance to speak with Paul at Dr. Anonymous’ Blog Talk Radio show tonight. You should listen to the podcast to learn more about the world of hospital administration, Paul’s life journey, and what constitutes quality care in medicine. Here are some choice quotes from the call:
“I’m from New York, actually, which is something you don’t say very often when you live in Boston. I have to explain that I really didn’t want to be born in New York but my mother was there and I felt it would be appropriate to be near her during the time of childbirth… And I want to make it absolutely clear that I root for the Red Sox…
Well, personally I have a checkered past. I had no idea I was going to do this [hospital administration.] My background is in the energy field and telecommunications. I used to regulate the utilities in Massachusetts, then the state energy department in Little Rock, Arkansas, and then I ended up running the water and sewer system in the greater Boston area. I guess running a sewer system is good training for running a hospital…
There had been a merger of Beth Israel and Deaconess in the mid 1990s. The merger failed and the place was about to go out of business. I thought it was worth saving, so I persuaded them to hire me. It’s not the usual path. I hope that not too many other hospitals that are failing would want to hire the guy who runs the sewer system.”
So there you have it, folks. Sometimes the best CEOs may be found in unusual places… Kudos to Paul Levy for spearheading a major hospital turn around, and kudos to the Harvard system for recognizing leadership excellence in an unexpected corner of the world. Listen to the podcast to find out more about this fascinating story.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
